Robles Nicolás Roberto, Cancho Barbara, Ruiz-Calero Rosa, Angulo Enrique, Sanchez-Casado Emilio
Unidad de Hipertension Arterial, Hospital Infanta Cristina, Badajoz, Spain.
Ren Fail. 2003 Sep;25(5):829-37. doi: 10.1081/jdi-120024297.
There are controversial reports in the prevalence of abnormal nighttime blood pressure fall in renal patients. It has been evaluated nocturnal BP in renal patients using 24 h blood pressure monitoring (ABPM) in comparison with nontreated control subjects either normotensives or hypertensives.
It has been reviewed 137 ABPM studies performed in renal patients (47.8 +/- 15.4 years, 76 men and 61 women). The control group includes 119 subjects without kidney disease, 65 were normotensives, and 49 were hypertensives, aged 46.8 +/- 12.1 years, 59 men and 60 women. The ambulatory BP was measured noninvasively for 24h by the SpaceLabs 90207 device programmed to measure BP every 15 min during daytime and every 20 min during nighttime. The definition of daytime and nighttime was made on the basis of wakefulness and sleep or bed rest periods, obtained from a diary kept by each subject.
SBP, but not DBP, was higher (133.9/81.7) in renal disease patients when compared to nonrenal subjects (127.9/80.8, p < 0.01). When the control group was split into normotensive and hypertensive patients there were still significant differences, but hypertensives had higher BP than renal disease patients (139.0/89.7, p < 0.05). Nocturnal SBP fall in renal disease patients was reduced (5.8%, p < 0.001) and so was DBP fall (11.1%, p < 0.001) compared with the overall nonrenal patients sample (SBP 10.8; DBP 15.3%). The frequency of nondipper status in renal disease patients (39.6%) was higher than in control patients (18.4%, p < 0.001). Nontreated normotensive renal disease patients did not show any difference in either SBP or DBP nighttime fall with respect to control normotensives. Neither do nontreated hypertensive renal patients as compared with control hypertensives. There were not differences between proteinuric and nonproteinuric patients in nocturnal BP fall. The same result was obtained when hypertensive and normotensive nontreated renal patients were compared. The presence of renal failure did not induce a reduction of nocturnal BP fall. Most of treated renal patients were mainly receiving drug therapy during the morning and frequently this was the single daily dose.
Altered diurnal rhythm should not be considered as a usual complication of renal disease. Inadequate antihypertensive pharmacotherapy could be related to the abnormalities of nighttime BP fall when it is detected.
关于肾病患者夜间血压异常下降的患病率，存在有争议的报道。已通过24小时血压监测（ABPM）对肾病患者的夜间血压进行了评估，并与未经治疗的正常血压或高血压对照受试者进行了比较。
回顾了137项在肾病患者中进行的ABPM研究（年龄47.8±15.4岁，男性76例，女性61例）。对照组包括119名无肾脏疾病的受试者，其中65名是正常血压者，49名是高血压患者，年龄46.8±12.1岁，男性59例，女性60例。使用SpaceLabs 90207设备进行24小时动态血压无创测量，该设备设置为白天每15分钟测量一次血压，夜间每20分钟测量一次血压。白天和夜间的定义是根据每个受试者记录的日记中的清醒和睡眠或卧床休息时间来确定的。
与非肾病受试者（127.9/80.8，p<0.01）相比，肾病患者的收缩压（SBP）较高（133.9/81.7），但舒张压（DBP）无差异。当将对照组分为正常血压和高血压患者时，仍存在显著差异，但高血压患者的血压高于肾病患者（139.0/89.7，p<0.05）。与总体非肾病患者样本（SBP下降10.8%；DBP下降15.3%）相比，肾病患者夜间SBP下降幅度降低（5.8%，p<0.001），DBP下降幅度也降低（11.1%，p<0.001）。肾病患者非勺型状态的发生率（39.6%）高于对照患者（18.4%，p<0.001）。未经治疗的正常血压肾病患者在SBP或DBP夜间下降方面与正常血压对照者无差异。未经治疗的高血压肾病患者与高血压对照者相比也无差异。蛋白尿患者和非蛋白尿患者在夜间血压下降方面无差异。将未经治疗的高血压和正常血压肾病患者进行比较时，也得到了相同的结果。肾衰竭的存在并未导致夜间血压下降幅度降低。大多数接受治疗的肾病患者主要在早晨接受药物治疗，且通常为每日单次剂量。
不应将昼夜节律改变视为肾病的常见并发症。当检测到夜间血压下降异常时，降压药物治疗不足可能与之相关。
